2022 Summer Enrichment Child Registration Form

Parents & Alternate Emergency Phone Numbers for Day & Night

Medical Release and Information

I give permission for the Director and/or Staff to take my child (name listed above) to the hospital for medical treatment, in case of an accident or illness, and to receive medication(s) prescribed by the attending physician(s).

Please answer all the following questions:

I give permission for my child (name listed above) to participate in all activities, including water activities, during the Fifth Ward Church of Christ 2022 Summer Enrichment Program.

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2022 Summer Enrichment Volunteer Form

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